21 research outputs found
Impact of extramedullary disease in patients with newly diagnosed multiple myeloma undergoing autologous stem cell transplantation: A study from the Chronic Malignancies Working Party of the EBMT
We investigated extramedullary disease in newly diagnosed multiple myeloma patients and its impact on outcome following first line autologous stem cell transplantation. We identified 3744 adult myeloma patients who received upfront single (n = 3391) or tandem transplantation (n = 353) between 2005 and 2014 with available data on extramedullary in-volvement at diagnosis. The overall incidence of extramedullary disease was 18.2% (n = 682) and increased per year from 6.5% (2005) to 23.7% (2014). Paraskeletal involvement was found in 543 (14.5%) and extramedullary organ involvement in 139 (3.7%) while the majority of 3062 (81.8%) patients had no extramedullary disease. More patients with extramedul-lary organ involvement had multiple involved sites (>/=2;) (p < 0.001). In patients with single sites compared to patients without the disease, upfront transplantation resulted in at least similar 3-year progression-free survival (paraskeletal: p = 0.86, and extramedullary organ: p = 0.88). In single paraskeletal involvement, this translated less clearly into 3-year overall survival (p = 0.07) while single organ involvement was significantly worse (p = 0.001). Multiple organ sites were associated with worse outcome (p < 0.001 and p = 0.01). First line treatment with tandem compared with single transplantation resulted in similar survival in patients with extramedullary disease at diagnosis (p = 0.13, respectively)
Impact of extramedullary disease in patients with newly diagnosed multiple myeloma undergoing autologous stem cell transplantation: a study from the Chronic Malignancies Working Party of the EBMT
We investigated extramedullary disease in newly diagnosed multiple myeloma patients and its impact on outcome following first-line autologous stem cell transplantation. We identified 3744 adult myeloma patients who received up-front single (n=3391) or tandem transplantation (n=353) between 2005 and 2014 with available data on extramedullary involvement at diagnosis. The overall incidence of extramedullary disease was 18.2% (n=682) and increased per year from 6.5% (2005) to 23.7% (2014). Paraskeletal involvement was found in 543 (14.5%) and extramedullary organ involvement in 139 (3.7%). More patients with extramedullary organ involvement had multiple involved sites (>= 2; P<0.001). In a comparison of patients with single sites with patients without the disease, up-front transplantation resulted in at least similar 3-year progression-free survival (paraskeletal: P=0.86, and extramedullary organ: P=0.88). In single paraskeletal involvement, this translated less clearly into worse 3-year overall survival (P=0.07) while single organ involvement was significantly worse (P=0.001). Multiple organ sites were associated with worse outcome (P<0.001 and P=0.01). First-line treatment with tandem compared with single transplantation resulted in similar survival in patients with extramedullary disease at diagnosis (P=0.13 for both)
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A LOFAR observation of ionospheric scintillation from two simultaneous travelling ionospheric disturbances
This paper presents the results from one of the first observations of ionospheric scintillation taken using the Low-Frequency Array (LOFAR). The observation was of the strong natural radio source Cassiopeia A, taken overnight on 18â19 August 2013, and exhibited moderately strong scattering effects in dynamic spectra of intensity received across an observing bandwidth of 10â80 MHz. Delay-Doppler spectra (the 2-D FFT of the dynamic spectrum) from the first hour of observation showed two discrete parabolic arcs, one with a steep curvature and the other shallow, which can be used to provide estimates of the distance to, and velocity of, the scattering plasma. A cross-correlation analysis of data received by the dense array of stations in the LOFAR âcoreâ reveals two different velocities in the scintillation pattern: a primary velocity of ~20â40 msâ1 with a north-west to south-east direction, associated with the steep parabolic arc and a scattering altitude in the F-region or higher, and a secondary velocity of ~110 msâ1 with a north-east to south-west direction, associated with the shallow arc and a scattering altitude in the D-region. Geomagnetic activity was low in the mid-latitudes at the time, but a weak sub-storm at high latitudes reached its peak at the start of the observation. An analysis of Global Navigation Satellite Systems (GNSS) and ionosonde data from the time reveals a larger-scale travelling ionospheric disturbance (TID), possibly the result of the high-latitude activity, travelling in the north-west to south-east direction, and, simultaneously, a smaller-scale TID travelling in a north-east to south-west direction, which could be associated with atmospheric gravity wave activity. The LOFAR observation shows scattering from both TIDs, at different altitudes and propagating in different directions. To the best of our knowledge this is the first time that such a phenomenon has been reported
Plasma pre-treatments and treatments for reducing the hydrobhobic recovery and obtaining permanently wettable polytetrafluoroethylene
When uncertainty generates more anxiety than severity: the prenatal experience with cystic adenomatoid malformation of the lung
Aim: To assess reasons for higher levels of anxiety generated by prenatal counselling of a condition with good outcome such as cystic adenomatoid malformation (CCAM) of the lung compared to a life-threatening malformation such as congenital diaphragmatic hernia (CDH). Materials and methods: The Spielberger State-Trait Anxiety Inventory (STAI-S) was used to measure anxiety in two groups of mothers carrying a fetus with the respective malformation. Results: Forty-four mothers completed the questionnaire (CCAM, n=21 and CDH, n=23). Before consultation, the mean STAI-S scores in the CCAM group (44.80±5.92) and in CDH group (44.05±4.96) were not significantly different but was significantly reduced in both groups after consultation (CCAM 44.80 vs. 41.60, P=0.014 and CDH 44.05 vs. 34.35, P=0.0001). The groups were not significantly different regarding gestational age at diagnosis. Conclusions: After initial prenatal counselling, uncertainty about prenatal outcome and lack of defined management plans in CCAM seems to be more important than higher mortality rate occurring in CDH.Peer Reviewe
Pregnancy after laparoscopic gastric banding: Maternal and neonatal outcomes
Introduction: Laparoscopic Adjustable Gastric Banding (LAGB) is a safe and effective treatment for
obesity. A strong evidence links weight loss with improved fertility outcomes and reduced gestational
complications in subsequent pregnancies. Our aim is to describe the impact of LAGB on maternal and
neonatal outcomes.
Methods: Data were collected retrospectively from the database of our University Center for the Multicentric
Treatment of Severe Obesity. From January 2006 to December 2011, 438 patients underwent
LAGB. Of these, 140 women of reproductive age (18e46 years old) were included in our study. The
following parameters were registered during follow-up: number of pregnancies, delivery and miscarriage,
time from LAGB to pregnancy, band adjustments, weight gain during pregnancy, gestational and
obstetrical complications (gestational diabetes mellitus, hypertensive disorders, prolonged labor), mode
of delivery, neonatal birth weight and complications (low birth weight, IUGR, prematurity, macrosomy).
Results: We registered 26 pregnancies with a total of 22 babies born and 4 miscarriages. The mean time
from LAGB to pregnancy was 15.8 months. Band adjustments were performed in 100% of patients during
the first trimester; the average weight gain at the end of pregnancy was 14.66 kg. None presented
gestational or obstetrical complications. One patient presented band slippage, which required surgery,
and one patient presented iron-deficiency anemia. 100% of deliveries were by cesarean section. No
perinatal complications or malformations were recorded, and the average baby weight was 3027 g.
Conclusion: LAGB is a safe procedure, well tolerated during pregnancy and without negative implications
on both the mother and the baby. According to our experience and recent studies, band loosening should
be reserved to symptomatic patients to avoid unhealthy weight gain
Trocar site hernia after bariatric surgery: Our experience without fascial closure
Introduction: The spreading of laparoscopic surgery has increased the occurrence of trocar site hernias,
along with their related complications. Bariatric surgery combines two important risk factors in hernia
formation: obesity and complexity of port-site closure. Several techniques and devices have been proposed
to close the trocar wounds to minimize the risk of hernia occurrence.
Materials and methods: The records of 624 obese patients who underwent laparoscopic bariatric procedures
between January 2006 and December 2012 were retrospectively reviewed. In no patient was
performed the closure of the fascial layers of trocar incisions. Weight, BMI, E%WL and onset of complications
were monthly collected for the first year after the procedure, then every six month.
Results: 10 patients showed trocar site hernia, for an overall prevalence of 1.6%. The mean time of
occurrence was 15 months. None developed intestinal obstruction or other complications as a consequence
of the hernia. The mean time of follow-up was 54 months. The mean weight and BMI before
interventions were 136.3 ± 17.7 kg and 46.0 ± 4.6 kg/m2 respectively. The mean percentage of excess
weight loss (E%WL) at one year was 45.9%.
Conclusion: We avoided complicating the wound closure with fascia closure, accepting the risks related
to the BMI. So far our procedure for port-site closure is relatively simple, safe, less invasive, less timeconsuming
and costless. These advantages could arise from the fact that our patients benefit from a
remarkable weight loss after the intervention thus reducing one of the most important risk factors in the
onset of trocar site hernia